Christine Parseghian, MD

Positioning fruquintinib and regorafenib against each other, and against trifluridine and tipiracil plus bevacizumab, increasingly comes down to individual tolerability, disease burden, and appropriate dose escalation strategy.

The SUNLIGHT trial redefined third-line expectations by pairing trifluridine and tipiracil with bevacizumab, while emerging every-other-week dosing data promise better tolerability without sacrificing efficacy.

Unresolved questions about immunotherapy duration, right-sided tumor biology, and earlier use of targeted agents illustrate how much remains unsettled in first- and second-line colorectal cancer management.

Early planning for third-line therapy, guided by subtle clinical and biochemical signals, now shapes how oncologists distinguish a true treatment rechallenge from a simple reintroduction of prior therapy.

Defining treatment failure depends on disease burden and biology, while circulating tumor DNA offers real but still limited practical value in guiding second-line therapy selection for metastatic colorectal cancer.

KEYNOTE-177 and CheckMate-8HW established immunotherapy as the frontline standard for MSI-high and deficient mismatch repair colorectal cancer, though managing the smaller subset of patients who progress remains genuinely complex.

Choosing between FOLFOX and FOLFIRI, and deciding when to shift to maintenance therapy, requires balancing prior treatment exposure, patient lifestyle, and the limited pool of active agents in colorectal cancer.

Comprehensive upfront biomarker testing, including RAS, BRAF, HER2, and MSI status, now anchors first-line treatment selection in metastatic colorectal cancer, though reflexive testing adoption still varies across practice settings nationwide.

Panelists discuss how support networks and coordinated care are essential for delivering third-line metastatic colorectal cancer therapies effectively in the community.

Panelists discuss how addressing barriers and sharing real-world data can increase community confidence in prescribing third-line metastatic colorectal therapies.

Panelists discuss how community and academic settings differ in applying third-line therapies for metastatic colorectal cancer and how collaboration benefits patients.

Panelists discuss how future RWE should expand to include survival, quality of life, and safety data to improve third-line mCRC care.

Panelists discuss how RWE informs treatment and safety decisions for special populations such as patients with ECOG PS 2 with metastatic colorectal cancer.

Panelists discuss how PROs, particularly tolerability and fatigue, guide shared decision-making for third-line therapy in mCRC.

Panelists discuss how real-world outcomes inform patient conversations and support shared decision-making for third-line metastatic colorectal cancer therapies.

Panelists discuss how RWE helps guide sequencing choices when head-to-head trial data are lacking in third-line metastatic colorectal cancer.

Panelists discuss how efficacy, safety, quality of life, and patient-specific factors drive selection among third-line therapies in metastatic colorectal cancer.

Panelists discuss how data from FRESCO-2 and other trials position fruquintinib as a strong third-line option compared with regorafenib and FTD/TPI.

Panelists discuss how the SUNLIGHT trial and real-world evidence support FTD/TPI with or without bevacizumab as an effective third-line option in metastatic colorectal cancer.

Panelists discuss how available third-line therapies, such as FTD/TPI, regorafenib, and others, are chosen based on survival data, safety, and patient quality of life.